The present invention relates generally to the field of surgery. More particularly, the invention relates to an apparatus and method for performing a hydraulically modulated surgical action for minimally invasive surgery.
Recently, there has been a considerable interest in the strategic improvement of traditional surgical methods. Many traditional forms of xe2x80x98openxe2x80x99 surgery may produce significant trauma to the patient because of the need to access and stabilize a surgical site. For example, conventional coronary artery bypass graft (CABG) surgery may involve a medial sternotomy and connection to a heart-lung machine so that the surgeon may work on an exposed and still heart. Because of the trauma, the patient may experience a prolonged recovery time, increased pain and complications, and an overall worsening in prognosis.
Minimally invasive surgery (MIS) is advantageous over traditional forms of xe2x80x98openxe2x80x99 surgery because the overall trauma posed to the patient is reduced. Many xe2x80x98openxe2x80x99 surgeries are now being adapted to be minimally invasive. For example, novel techniques have been developed for performing CABG surgery in a minimally invasive fashion. MIS procedures, such as those used for CABG, typically involve insertion of special surgical instruments such as an endoscope through small incisions in the skin of a patient. The instruments may then be manipulated remotely at the hands of a surgeon. The MIS instruments may perform many of the actions of traditional surgical instruments including grasping objects, suturing, harvesting blood vessels, etc. In this manner, effective MIS may be achieved while reducing many of the deleterious effects associated with xe2x80x98openxe2x80x99 surgery.
One problem associated with MIS instruments, as well as traditional surgical instruments, relates to stability. A certain level of tremor is inherent in the human hand. In many instances, a surgeon""s xe2x80x98steadyxe2x80x99 hand is needed to effectively perform surgical actions. For example, effective suturing of small blood vessels requires a stable control of the suturing instrument. Many MIS and traditional instruments are not capable of reducing the hand tremor thereby limiting the effectiveness of the tool. Therefore, it would be desirable to effectively reduce the inherent instability associated with hand manipulation of surgical instruments.
Another problem associated with MIS instruments, as well as traditional surgical instruments, relates to precision. For procedures such as minimally invasive CABG, extremely small sutures must be emplaced in various locations proximate the heart. As such, precise control of the motion of the instrument is required. Many traditional instruments do not afford the precision required for such procedures. Therefore, it would be desirable to increase the precision of the surgical instrument. In addition, it may be desirable to perform surgical actions on a minute scale. For such instances, it would be desirable to achieve a level of precision greater than the human hand.
Another problem associated with MIS instruments relates to a limited range of motion. Ideally, the instrument should be able to replicate all of the movements possible (as well as some movements not possible) while in the surgeon""s hand. For example, during xe2x80x98openxe2x80x99 surgery, a traditional instrument may be manipulated with six degrees of free movement. During MIS, however, the instruments may be limited to four degrees of free movement or less. This loss of free movement within the surgical site may substantially limit the effectiveness of the procedure to an extent to which it may not be performed in a minimally invasive fashion. As such, it would be desirable for an MIS instrument to have six degrees of free movement.
Therefore, it would be desirable to provide a strategy for performing minimally invasive surgery on a patient that would overcome the aforementioned and other disadvantages.
One aspect of the present invention provides an apparatus for performing surgery on a patient. The surgical apparatus includes an input device, at least one hydraulic amplifier operably attached to the input device, and an actuator operably attached to the hydraulic amplifier. Input to the input device is hydraulically modulated via the hydraulic amplifier to manipulate the actuator. The input may be provided by a hand of a surgeon. The apparatus may include hydraulic fluid carried by at least one hose for communication between the input device, the at least one hydraulic amplifier, and the actuator. The hydraulic fluid may be a biocompatible fluid such as a saline solution.
The input device may include at least one joystick, lever, dial, and/or button for receiving the input, and an adaptor including at least one hydraulic cylinder operably attached to the at least one joystick, lever, dial, and/or button. The hydraulic cylinder may transmit the received input from the input device. The adaptor may include an adaptor wrist portion, and an adaptor arm portion operably attached to the adaptor wrist portion with a first adaptor ball joint. The adaptor may further include an adaptor sled slidably carried within an adaptor housing and operably attached to the adaptor arm portion with a second adaptor ball joint. An adaptor range of motion of at least one axis of motion may be provided.
The hydraulic amplifier may include a housing including a first opening and a second opening formed therein. The hydraulic amplifier may further include a first amplifier piston slidably carried in the first opening, and a second amplifier piston slidably carried in the second opening. Movement of the first amplifier piston may produce a modulated movement of the second amplifier piston.
The actuator may include at least one gripper, and a manipulator including at least one hydraulic cylinder operably attached to the gripper. The hydraulic cylinder may transmit the modulated input to the gripper for manipulating a surgical instrument operably attached to the actuator. The surgical instrument may include a gripping device, a cutting device, a sealing device, a hemostatic device, a clamping device, a cauterizing device, a suturing device, an ablation device, an anastomotic device, a stabilizing device, a positioning device, a retention device, a video device, a laser device, a harvesting device, an electrical current delivery device, a drug delivery device, a cell delivery device, a gene delivery device, and/or a lead delivery device. The actuator may be manufactured from an injection molded plastic material with an optional insert molded steel material.
The manipulator may include a manipulator wrist portion, and a manipulator arm portion operably attached to the manipulator wrist portion with a first manipulator ball joint. The manipulator may further include a sled slidably carried within a manipulator housing and operably attached to the manipulator arm portion with a second manipulator ball joint. A manipulator range of motion of at least one axis of motion may be provided. The first and second manipulator ball joint may be a spring-loaded joint.
Another aspect of the present invention provides a method for performing surgery on a patient. The surgical method includes receiving a mechanical input for an action. The mechanical input is hydraulically modulated. The action is controlled based on the hydraulically modulated input. Receiving the mechanical input may include translating hand movement of a surgeon. Modulating the mechanical input may include dampening, increasing precision, and increasing a resulting force of the mechanical input. The mechanical input may be transmitted from an input device to a surgical site. The action may be performed on an organ of a patient, such as a beating heart. The action may include gripping, impeding blood flow, clamping, cauterizing, suturing, ablating, joining, sealing, cutting, stabilizing, positioning, retaining, viewing, harvesting, bypassing, delivering an electrical current, delivering a therapeutic agent, delivering a diagnostic agent, delivering a genetic agent, and delivering a cellular agent.
The foregoing and other features and advantages of the invention will become further apparent from the following detailed description of the presently preferred embodiments, read in conjunction with the accompanying drawings. The detailed description and drawings are merely illustrative of the invention, rather than limiting the scope of the invention being defined by the appended claims and equivalents thereof.